Almost 25% of patients presribed an opioid for the first time will wind up using the drugs long-term, Mayo Clinic researchers report. Those with histories of tobacco use and substance abuse were the most likely to use opioid painkillers long-term.

Lead author W. Michael Hooten, M.D., Mayo Clinic anesthesiologist, said that although the study found past or present nicotine use and substance abuse were the top risk factors for long-term opoid use, all patients should use caution when given opioid painkiller prescriptions:

“From a patient perspective, it is important to recognize the potential risks associated with these medications. I encourage use of alternative methods to manage pain, including non-opioid analgesics or other nonmedication approaches. That reduces or even eliminates the risk of these medications transitioning to another problem that was never intended."

Researchers looked at a random sample of 293 patients from the National Institutes of Health-funded Rochester Epidemiology Project, who had been given a new prescription in 2009 for an opioid painkiller such as hydromorphone, fentanyl, meperidine, oxycodone, morphine, oxymorphone, hydrocodone, codeine or methadone.

21 percent, or 61 people, they found, progressed from short-term use to prescriptions lasting three to four months, and 6 percent, or 19, of the 293 studied ended up with more than a four-month supply of the drugs.

Long-term opioid use may actually make people more sensitive to pain, a condition named opioid-induced hyperalgesia, another recent study by Dr. Hooten and colleagues found.

Why is there such a connection between nicotine and substance abuse and long-term use of opioids?

The neurobiology related to chronic pain, chronic opioid use and addiction is similar, Dr. Hooten says. For example, nicotine activates a group of receptors, or brain structures, in a way very similar to how opioids and chronic pain may activate them.

Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing: A Population-Based Study W. Michael Hooten, Jennifer L. St Sauver, Michaela E. McGree, Debra J. Jacobson, David O. Warner Mayo Clinic Proceedings, Vol. 90, Issue 7, p850–856

Illustration: Fons Heijnsbroek/flickr

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